The acceptability, feasibility, and possible benefits of a neurobiologically‐informed 5‐day multifamily treatment for adults with anorexia nervosa

Wierenga, Christina E.; Hill, Laura; Peck, Stephanie Knatz; McCray, Jason; Greathouse, Laura; Peterson, Danika; Scott, Amber Lynn; Eisler, Ivan; Kaye, Walter H.

doi:10.1002/eat.22876

Cited by 42 publications

(59 citation statements)

References 36 publications

(36 reference statements)

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“…Recent findings [50][51][52][53] for olanzapine and aripiprazole suggest that investigation of medications targeting the dopamine system may improve eating behavior and reduce anxiety in AN. In addition, these findings support investigating behavioral strategies for enhancing initiation to eat or compensating for altered homeostatic drives 54,55 . Finally, a registry aimed at understanding how those with AN recover could be of much benefit in developing new treatment strategies.…”

Section: Discussionmentioning

confidence: 58%

Neural Insensitivity to the Effects of Hunger in Women Remitted From Anorexia Nervosa

Kaye

Wierenga

Bischoff‐Grethe

et al. 2020

AJP

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Objective: Anorexia nervosa (AN) has the highest mortality rate of any psychiatric condition, yet the pathophysiology of this disorder and its primary symptom-extreme dietary restrictionremains poorly understood. In states of hunger relative to satiety, the rewarding value of food stimuli normally increases to promote eating, yet individuals with AN avoid food despite emaciation. This study aimed to examine potential neural insensitivity to these effects of hunger in AN. Method: At two counterbalanced visits, one after a 16-hour fast and one after a standardized meal, 26 women remitted from AN (RAN; to avoid the confounding effects of malnutrition) and 22 matched control women (CW) received tastes of sucrose and water while functional MRI data were acquired. Within a network-of-interest responsible for food valuation and transforming taste signals into motivation to eat, we compared groups across conditions on blood-oxygen-leveldependent (BOLD) signal and task-based functional connectivity. Results: Subjects had similar BOLD responses to sucrose and water tastants. A Group x Condition interaction in the ventral caudal putamen indicated that hunger had opposite effects on tastant response in CW and RAN participants: CW showed an increase, and RAN showed a decrease, in BOLD response when hungry. Hunger had a similar opposite effect on insula-toventral caudal putamen functional connectivity in RAN compared with CW. Exploratory analyses indicated that lower caudate response to tastants when hungry was associated with higher harm avoidance among RAN participants.

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Section: Discussionmentioning

confidence: 58%

Neural Insensitivity to the Effects of Hunger in Women Remitted From Anorexia Nervosa

Kaye

Wierenga

Bischoff‐Grethe

et al. 2020

AJP

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“…Although we provide evidence for a relative normalization of some of these measures, for others, e.g., fALFF, the extent of normalization remains an open question. Overall, the presented evidence suggestive of normalization of spontaneous regional brain activity and connectivity may send a positive message to patients and could be useful information for patient education and psychotherapy 77 .…”

Section: Discussionmentioning

confidence: 75%

Evaluation of spontaneous regional brain activity in weight-recovered anorexia nervosa

et al. 2020

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Whereas research using structural magnetic resonance imaging (sMRI) reports sizable grey matter reductions in patients suffering from acute anorexia nervosa (AN) to be largely reversible already after short-term weight gain, many task-based and resting-state functional connectivity (RSFC) studies suggest persistent brain alterations even after long-term weight rehabilitation. First investigations into spontaneous regional brain activity using voxel-wise resting-state measures found widespread abnormalities in acute AN, but no studies have compared intrinsic brain activity properties in weight-recovered individuals with a history of AN (recAN) with healthy controls (HCs). SMRI and RSFC data were analysed from a sample of 130 female volunteers: 65 recAN and 65 pairwise age-matched HC. Cortical grey matter thickness was assessed using FreeSurfer software. Fractional amplitude of low-frequency fluctuations (fALFFs), mean-square successive difference (MSSD), regional homogeneity (ReHo), voxel-mirrored homotopic connectivity (VHMC), and degree centrality (DC) were calculated. SMRI and RSFC data were analysed from a sample of 130 female volunteers: 65 recAN and 65 pairwise age-matched HCs. Cortical grey matter thickness was assessed using FreeSurfer software. Fractional amplitude of low-frequency fluctuations (fALFF), mean-square successive difference (MSSD), regional homogeneity (ReHo), voxel-mirrored homotopic connectivity (VHMC), and degree centrality (DC) were calculated. Abnormal regional homogeneity found in acute AN seems to normalize in recAN, supporting assumptions of a state rather than a trait marker. Aberrant fALFF values in the cerebellum and the infertior temporal gyrus could possibly hint towards trait factors or a scar (the latter, e.g., from prolonged periods of undernutrition), warranting further longitudinal research.

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“…As such, interventions targeting task-switching may be best suited to individuals with AN and comorbid anxiety, and targeting anxiety using other empirically supported interventions could decrease difficulties with task switching. Overall, interventions that address behavioral flexibility, such as cognitive remediation therapy (Tchanturia, Giombini, Leppanen, & Kinnaird, 2017), Radically Open Dialectical Behavior Therapy (Lynch et al, 2013;Lynch, Hempel, & Dunkley, 2015), the Maudsley Model of Anorexia Nervosa Treatment for Adults (Schmidt, Wade, & Treasure, 2014), and Temperament Based Treatment (Wierenga et al, 2018), may be important in targeting task-switching deficits in IAN.…”

Section: Discussionmentioning

confidence: 99%

Task‐switching inefficiencies in currently ill, but not remitted anorexia nervosa

Berner

Romero

Reilly

et al. 2019

Intl J Eating Disorders

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Objective Models of anorexia nervosa (AN) posit that set‐shifting deficits may contribute to behavioral inflexibility and extreme dietary restriction. Findings from neurocognitive studies of set‐shifting in AN have been somewhat mixed, perhaps due to the use of tasks that cannot distinguish shifting from other processes (i.e., learning). To more precisely characterize cognitive flexibility and selectively assess this process independent of rule learning and feedback sensitivity, we examined task‐switching ability in AN. Method Women ill with AN, subthreshold AN or atypical AN (IAN; n = 40), women remitted from AN (RAN; n = 24), and age‐matched healthy control women (n = 42) completed a computerized cued color‐shape task‐switching paradigm. Groups were compared on mix costs (reflecting global cognitive control) and switch costs (reflecting transient cognitive control). Results Although mix costs were equivalent across groups, switch costs were more pronounced in the IAN group, as indicated by a group‐by‐trial type interaction for reaction times on stay and switch trials. Discussion Findings indicate that IAN, but not RAN, have difficulty flexibly switching between cognitive task sets, and suggest that prior findings of set‐shifting deficits in AN may reflect difficulty with cognitive flexibility independent of learning deficits. As such, task‐switching may represent a promising adjunctive treatment target.

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The acceptability, feasibility, and possible benefits of a neurobiologically‐informed 5‐day multifamily treatment for adults with anorexia nervosa

Abstract: Preliminary results are promising and suggest this novel treatment is feasible and acceptable. To establish treatment efficacy, fully-powered randomized controlled trials are necessary.

Cited by 42 publications

References 36 publications

Neural Insensitivity to the Effects of Hunger in Women Remitted From Anorexia Nervosa

Neural Insensitivity to the Effects of Hunger in Women Remitted From Anorexia Nervosa

Evaluation of spontaneous regional brain activity in weight-recovered anorexia nervosa

Task‐switching inefficiencies in currently ill, but not remitted anorexia nervosa

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